44-790.01. Covered prescription insulin drug; maximum payment; ensure access; requirements.

268 words·~1 min read·/ne/chapter-44/44-790-01

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(1)Except as provided in subsection

(3)of this section, beginning January 1, 2024, and notwithstanding section 44-3,131 ,

(a)any individual or group sickness and accident insurance policy or subscriber contract delivered, issued for delivery, or renewed in this state and any hospital, medical, or surgical expense-incurred policy, except for policies that provide coverage for a specified disease or other limited-benefit coverage, and

(b)any self-funded employee benefit plan to the extent not preempted by federal law, which provides reimbursement for prescription insulin drugs shall limit the total amount that a covered individual is required to pay for each covered prescription insulin drug on the policy's, contract's, or plan's lowest brand or generic tier to a maximum of thirty-five dollars per thirty-day supply of insulin, regardless of the amount needed.

(2)Nothing in this section prevents a policy, contract, or plan from reducing the total amount that a covered individual is required to pay for each covered prescription insulin drug to an amount less than the maximum specified in subsection

(1)of this section.

(3)If, due to a national shortage of an insulin drug, a covered individual cannot access a covered prescription insulin drug on the lowest brand or generic tier of the policy, contract, or plan, the policy, contract, or plan shall ensure access to an insulin drug at a maximum of thirty-five dollars per thirty-day supply, until such time that the national shortage ends to prevent disruptions in patient access to insulin.

(4)For purposes of this section, prescription insulin drug means a prescription drug that contains insulin and is used to treat diabetes.